Commercial fishing is among the most hazardous occupations, with high rates of both fatal and nonfatal injury. Nevertheless, few studies have been conducted to examine the epidemiology and prevention of injuries among commercial fishers in the United States. We propose a prospective cohort study of occupational injuries among commercial fishers, with the following aims: 1) To measure the incidence of nonfatal occupational traumatic injuries and musculoskeletal disorders; 2) To characterize the types and severity of occupational traumatic injuries and musculoskeletal disorders; 3) To describe and characterize the work processes, equipment, and working conditions, using qualitative, as well as quantitative methods; 4) To determine the association of occupational injuries with specific aspects of the job, including the type of fishing, size of vessel, equipment, and environmental conditions, and 5) To identify risk factors that could be modified to reduce the risk or severity of injury. The study will be carried out via intensive, two-year prospective follow-up of a cohort of commercial fishers in Eastern North Carolina. The cohort will be characterized in detail by clinical evaluations conducted at entry and every six months thereafter, and incident injuries will be ascertained prospectively by telephone interviews conducted weekly during the fishing season. This follow-up strategy will yield high quality data, allowing accurate ascertainment of injury occurrence in a population that is ordinarily hard to study because of their geographic dispersal and irregular work schedules. The statistical analysis will use state-of-the-art methods for repeated measures data. In addition to providing high-quality data an unstudied, high-risk population, this project will employ an innovative blend of qualitative and quantitative methodologies. We will conduct a field study using ethnographic techniques to understand the work processes of fishing and add context to the quantitative analysis. Potential interventions will be identified and presented to key informants in the fishing population. This proposal directly addresses three NIOSH NORA priority areas: traumatic injury, low back disorders, and musculoskeletal disorders of the upper extremities and is pertinent to a research with special populations, another NORA priority.